OBJECTIVES: To study the pathogens, susceptibility patterns, and prevalence of urinary tract anomalies in hospitalized children with UTI.
METHODS: All children admitted with UTI between 1.4.1999-31.3.2000 were included. Urine and blood caltures were obtained on admission. Renal Ultrasound (RUS) was performed during the hospitalization and children younger than 6 years underwent voiding cystouretetography (VCUG)6-8 weeks after discharge. Dimercaptosuccinic Acid (DMSA) scan was performed in children with vesicoureteral reflux (VUR).
RESULTS:During the study period 151 children were admitted with UTI. The ages were one week-14 years (median 16 months), 119(79%) were males and 32(21%) males. The main pathogens were:E. coli:87%, Klebsiella pneumonia:4%, Proteus mirabilis:4%, Pseudomonas aeruginosa:2%, and Enterococcus fecalis :2%. Only 2(1.3%)of patients had bacteremia (due to E. coli). Gram negative rods constituted 985 of the pathogenic bacteria and their overall susceptibility patterns were as follows: Amikacin:100%, Tobramycin: 96%, Ceftazidime: 96%, Gentamicin:96%, Ceftriaxone:96%, Cefuroxime:95%, Amoxicillin-clavulanate: 84%, Trimethoprim-Sulfamethoxazole:63%, Cephalothin:60%, and Amoxicillin:28%. RUS showed minor anomalies in 17% of the children, and VCUG revealed VUR in 30% of patients with episode of UTI. DMSA scan revealed scars in 7(25%) of children with VUR.
CONCLUSIONS: E. coli is the leading cause of UTI in hospitalized children. Aminoglicosides, second and third generation cephalosporins are the best choice for empiric therapy. VUR and renal scars are frequent in children hospitalized with first episode of UTI.